Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2022 May 27;20:eAO6800. doi: 10.31744/einstein_journal/2022AO6800. eCollection 2022.
To analyze telemedicine diagnostic accuracy in patients with respiratory infections during COVID-19 pandemic compared to face-to-face evaluation in the emergency department.
Randomized, unicentric study between September 2020 and November 2020 in patients with any respiratory symptom (exclusion criteria: age >65 years, chronic heart or lung diseases, immunosuppressed). Patients were randomized 1:1 for brief telemedicine followed by face-to-face consultation or direct face-to-face evaluation. The primary endpoint was the International Classification of Diseases code. The secondary analysis comprised length of stay, diagnostic test ordering, medical prescription, and proposed destination.
Ninety-eight patients were enrolled. The mean age was 36.3±9.7 years old, 57.1% were women, and 81.6% had diagnostic test ordered. Mean grouped by International Classification of Diseases code for upper respiratory tract infection, pharyngotonsillitis, and sinusitis showed no difference between study groups or secondary endpoints. The Telemedicine Group was representative of the population usually evaluated in this center. In the Telemedicine Group (n=48), 18.7% patients would be referred for evaluation at the emergency department. The distribution of diagnoses by telemedicine was 67.4% for upper respiratory tract infection, 2.3% for pharyngotonsillitis, and 0% for sinusitis, being statistically similar to the subsequent face-to-face assessment, respectively: 72.1%, 11.6% and 7% (Kappa 0.386 [95%CI: 0.112-0.66]; p=0.536). Telemedicine ordered COVID-19 molecular (RT-PCR) tests in 76.5% versus 79.4% in face-to-face evaluation (Kappa 0.715 [95%CI: 0.413-1]; p>0.999).
Diagnostic telemedicine consultation of low-risk patients with acute respiratory symptoms is not inferior to face-to-face evaluation at emergency department. Telemedicine is to be reinforced in the health care system as a strategy for the initial assessment of acute patients. ClinicalTrials.gov Identifier: NCT04806477.
分析 COVID-19 大流行期间远程医疗诊断对急诊科呼吸感染患者的准确性，与面对面评估相比。
2020 年 9 月至 11 月，在有任何呼吸道症状的患者中进行了一项随机、单中心研究（排除标准：年龄>65 岁、慢性心脏或肺部疾病、免疫抑制）。患者以 1:1 的比例随机分配接受简短的远程医疗，然后再进行面对面咨询或直接面对面评估。主要终点是国际疾病分类代码。次要分析包括住院时间、诊断性检查、医疗处方和建议的去向。
共纳入 98 例患者。平均年龄为 36.3±9.7 岁，57.1%为女性，81.6%进行了诊断性检查。按国际疾病分类代码分组，上呼吸道感染、咽扁桃体炎和鼻窦炎的平均数值在研究组或次要终点之间无差异。远程医疗组代表了该中心通常评估的人群。在远程医疗组（n=48）中，18.7%的患者将被转至急诊科评估。远程医疗诊断的分布分别为：上呼吸道感染 67.4%、咽扁桃体炎 2.3%和鼻窦炎 0%，与随后的面对面评估结果相似：72.1%、11.6%和 7%（Kappa 值 0.386[95%CI：0.112-0.66]；p=0.536）。远程医疗组的 COVID-19 分子（RT-PCR）检测率为 76.5%，而面对面评估组为 79.4%（Kappa 值 0.715[95%CI：0.413-1]；p>0.999）。
对低危急性呼吸症状患者进行远程医疗咨询，其诊断效果不劣于急诊科的面对面评估。远程医疗应作为急性患者初始评估的一种策略，在医疗系统中得到加强。
NCT04806477。
